Aetna - appeals committee

Rekeca
on 6/26/11 11:36 pm - NC
I have been denied by Aetna for VSG. First because they stated I didn't meet the criteria of weightloss. However,  I appealed and proved that I do meed the medical criteria however,  they came back with a second denial because they say that I didn't meet psych clearance. Which was untrue. I faxed in the pysch clearance but now they want to do a Level II appeal committee tele - conference. I can choose to phone in and state my case to an unknown board I will be given 15 minutes to do this. Then I will be asked to leave the call where they will deliberate without me and send me a letter with their decision within 5 business days. They also state that I can have a lawyer present it I want to. WTF.  Does anybody have any experience with this? What should I expect?
    
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